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Buried milk blister? Thrush? Infection? Nipple pain

I have read all the posts on nipple pain (thanks!), but wanted some input as I wait back from a call to my midwives/LC.

My 6-mo is EBF (although started on solids last week) and is thriving and meeting milestones. Here is our issue:

Chronic nipple pain on one side only. Hurts worse as milk transfer starts, and gets a little better as feeding continues. In between feedings, I'm having frequent vasospasm (sometimes both sides, but mostly on this side.) Vasospasm is set off by cold or clothes rubbing.

6 weeks ago, we were both treated for thrush. LO had unmistakable symptoms and was put on nystatin, which worked immediately (completed full course.) I was put on diflucan for 2 weeks. I had slight improvement, but was not convinced yeast was causing my pain (but maybe adding to it?) I boiled/discarded pacifiers, washed clothes/towels after each wearing in hot, and used coconut oil each day.

Latch: LO has a bad, shallow latch because of a tight upper lip frenulum. We had this separated by an ENT at ~8 weeks, but it seems to have not worked/grown back? ENT was skeptical that lip ties have any affect on nursing. Do not plan to pursue further treatment for LO's mouth. He cannot flare his upper lip up at all.

Nipple status: nipple is not shiny or peeling, but the skin is dry and is coming off in small shreds. I can gently pull off this dead skin, but I try not to pick too much and make things worse. Sometimes the pain gets very bad during nursing and then suddenly better, and when I look there is a crater of skin, like my LO popped open something. There is no classic milk blister, but deep under the skin there is an irregularly shaped spot of yellowish white that looks like it could be a buried milk blister/bleb. It is hard to see unless I am in the shower (the warm water keeps the vasospasms from kicking in.) If I hand express, this area does not seem to bulge, but does get a bit whiter, as if the milk is coming from underneath it or over it.

History: I had the exact same thing happen with my older son (now almost 3). Nipple pain, shallow latch, lip tie ("resolved" by falling down stairs at age two). Same breast, but not as severe, chronic but not constant pain for the 19 months I nursed him. No thrush diagnosis. At almost the exact age (5 mo), it became worse, and I saw a LC. She was mostly concerned with his slow weight gain and we got sidetracked by increasing my supply. This time around, LO is much larger than his brother and supply is not an issue.

Unrelated(?) info: My adult brother is dealing with an open wound that has not healed in 4 years (!) He has been diagnosed with everything from yeast to staph to impetego. We live far apart and do not see each other often, but it has infections on my mind. Could I have a bacterial infection that doesn't spread or cause fever/malaise?

My theory: I think I have a buried milk blister that is covered over with layers of skin. Sometimes it gets close to the surface, but it doesn't seem to have ever popped completely. I have done some minor digging in the shower, but never got close enough. I have lanced milk blisters before, but this doesn't seem the same as a big, round one on the surface, so I'm hesitant to dig with a needle. Does this sound plausible?

As I mentioned, I'm going to talk to my midwives. I have a PCP but have never met her (have been pregnant or nursing for years and am healthy, so avoided doctors) but would consider calling the doctor if I thought she could help. Any input is appreciated!

Re: Buried milk blister? Thrush? Infection? Nipple pain

This is a for sure. Have you been varying your nursing position? If this is a blister, perhaps related to the lip tie, then maybe having the baby's mouth fall in a different orientation would help. And I am thinking that this could be a blister- they aren't always rounded bulges on the surface.. Sometimes you'll get a white dot deeper down.

Regarding the infection hypothesis, the dry skin shreds sound very thrush-y. I don't know that you could have a bacterial infection that stays in such a limited area... But it's worth talking about with the LC and your doc.

Regarding your brother, you might want to google pyoderma gangrenosum. I was just reading about this in the NY Times as a potential rare cause of non-healing wounds.

This is a for sure. Have you been varying your nursing position? If this is a blister, perhaps related to the lip tie, then maybe having the baby's mouth fall in a different orientation would help. And I am thinking that this could be a blister- they aren't always rounded bulges on the surface.. Sometimes you'll get a white dot deeper down.

Regarding the infection hypothesis, the dry skin shreds sound very thrush-y. I don't know that you could have a bacterial infection that stays in such a limited area... But it's worth talking about with the LC and your doc.

Regarding your brother, you might want to google pyoderma gangrenosum. I was just reading about this in the NY Times as a potential rare cause of non-healing wounds.